Urticaria (蕁麻疹)
Traditional Chinese medicine calls “urticaria” as wind eruption groups and considers that it is caused by accumulation of wind, wetness and heat in the skin. In fact, urticaria, similar to eczema, is an allergic skin disease. It is a kind of erythematous and edematous response of the skin, caused by the sudden increase of permeability and expansion of blood capillaries. In typical cases, there is first erythema and then edema, and it can happen in any part of the body, associated with intense itching. This disease relapses easily; it can disappear in a short time or may present a chronic course, persisting for several months or even years.
The cause of urticaria is commonly hypersensitivity of the patient to certain internal or external stimulants. The allergins include biogenic substances (like virus and bacterial infections, parasitic invasion, insect bites etc), food (like lobsters, crabs having heterologous protein, spice, strawberry etc), drugs (sulfa agents, antibiotics, serum etc). In addition, if the patient is deficient in blood and possesses an allergic constitution, wind, temperature, sweating and anxiety would induce the disease.
Urticaria, according to TCM clinical classification, can be divided into 2 types: the wind-heat form (acute) and wind-cold form (chronic). The former is characterized by hotness of skin, erythema and eruptions, persistent itching exacerbated by wind, and if severe, edema of face and lips or abdominal pain. In extremely serious cases, angioneurotic edema (血管神經性的水腫) may occur and may involve the pharynx where pharyngeal edema may hinder respiration. Physical examination may reveal redness of tongue, thin coating with yellowish or white color and rapid pulse.
The wind-cold form shows repeated attacks of skin eruptions, the lesions lighter in color, the tongue pale or with thin white coating, the pulse slow and deep. Urticaria in infants may form vesicles and leave brownish yellow scars; they often occur repeatedly and are called “pigmented urticaria”. If the wheals show popular and vesicular presentations, and appear in conglomerate groups, they are also called infantile lichen. These lesions appear at the extensor surface of the limbs, especially the lower extremities and itching causes uneasiness and crying of the infant.
In fact, urticaria is closely related to hepatophilic virus infection. In our cases having abnormality of hepatic region, the data showed that in the 512 cases associated with skin illnesses, urticaria appeared in 74 cases, occupying 14.5% and many came to the clinic chiefly because of this illness. When chronic hepatitis is cured clinically by systemic TCM therapy, the urticaria, although ineffectively treated with WM and TCM drugs by dermatologists, can also be cured simultaneously. But, it should be mentioned that in treating urticaria TCM emphasizes on “deficiency of blood generates wind”, so that, if patients with deficiency of qi and blood suffer from urticaria, the correction of “deficiency of blood” may frequently result in rapid control of urticaria.
Introduction of cases
| Case 10
Tang (code number 269) female, age 34 years. She first visited the clinic on May 1994 with the chief complaint of repeated urticaria for several months. She was a vegetarian for several years and for the disease, she received WM and TCM treatment with no avail. Her menstruation was painful for a long time and was associated with irregularity and blood clots. Physical examination: poor nourishment, anemic, normal development, scattered urticaria over the limbs with pale red color, demarcated edges and geographic appearance, hepatomegaly of 3cm. The diagnosis was chronic hepatitis with TCM classification of the “deficiency of qi and blood form”, “wetness-heat vaporization form” and “blockage of channel and stasis of blood form”, associated with anemia, wind-cold form urticaria. After 6 parcels of TCM drugs, the liver regressed to 1.5 cm and the urticaria disappeared. Another 3 parcels brought the liver to normal. Therapy was stopped after 6 weeks of TCM treatment and afterwards, the patient was followed up. Observation continued for 6 years. Her menstruation was regular since TCM treatment and the color was bright, there was no pain and clots. The liver was normal. Urticaria did not relapse after clinical cure of the liver disease and correction of anemia.
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| Case 11
Yan (code number 2178) male, age 36 years. He was a carpenter specialized in renovation. His first visit was on July 2000 with the complaint of repeated urticaria for 5 years, not responding to WM or TCM treatment. The urticaria occurred everywhere in the body except the head and they usually persisted for several hours. The lesions were circular, the diameter reaching 5cm and extremely itching. Nasal hypersensitivity occurred repeatedly for 8 years. In the past, he often suffered from stomache ache, abdominal distention and drunkenness and recently, fatigue, hot feeling of the palms, soles and chest and constipation. He was still taking anti-allergic agents because of prolonged dermal hypersensitivity. Physical examination: tongue enlarged with teeth prints and ecchymoses at the edge, abdomen distended with tympanites, percussion tenderness over hepatic region, hepatomegaly of 3 cm. His illness was diagnosed as chronic hepatitis with TCM classification of “liver stagnation and lung dryness form”, “wetness-heat vaporization form” associated with wind-heat form urticaria. After 3 parcels of TCM drugs, the liver was normal, the hot sensation and fatigue abated and the urticaria markedly regressed. He stopped the anti-allergic drugs, although there were few small urticaria eruptions occurring at dusk. These lesions subsided easily and did not cause much itching. After 2 weeks of TCM drugs, the urticaria disappeared. He took sea food broth and beef extract but did not get urticaria. His body weight dropped from 140 lbs to 135 lbs. Systemic TCM therapy continued for 6 weeks, at which time clinical cure was obtained and treatment was stopped. On 3rd December 2001, he had a return visit because of headache, nausea, abdominal distention, diarrhea and stomache ache after eating roast food. The liver was normal and the urticaria did not relapse since the previous treatment. |
By WONG Kwok Hung
published on 13th November 2001
(translated by Professor ZHENG Hua En in 2003)